Citizens Memorial Healthcare (CMH) will establish the standardization efforts necessary for data capture of quality measures in an ambulatory EMR system and demonstrate the efficiency and accuracy of using a data extraction and reporting expert to perform quality measurement in the ambulatory care setting. CMH will standardize and integrate data capture for quality of care measurement into the normal documentation of care within the ambulatory EMR. The standardization effort will include both tools and processes for physician documentation, medication prescription ordering and collection and recording of allergies. Workflow analysis will be used to examine existing processes and design new, standard processes to be implemented. Proven adoption strategies will be used to assist providers in learning and adapting to the changes in processes. [unreadable] Using the resulting standardized data elements, CMH will implement an automated system for data [unreadable] extraction of quality measures in the ambulatory setting. Data will be mapped, linked, extracted, [unreadable] normalized, analyzed, reported and prepared for export by a quality data extraction partner. [unreadable] The study will be conducted in 15 primary care, certified rural health clinics and specialty physician practices affiliated with CMH, including 60 physicians and nurse practitioners. [unreadable] Research Design: The research will include a measure of how many consensus quality measures can [unreadable] be captured in "extractable" formats from the ambulatory EMR and a comparison of the automatic data extraction with the G-code quality reporting method currently used by CMS. The evaluation will include comparisons both before and after standardization of tools and processes and comparisons of the both methodologies used simultaneously in a standardized environment. [unreadable] [unreadable] [unreadable] [unreadable]